Immediate Cardioversion During Left Atrial Appendage Occlusion in Three Patients With Left Atrial Appendage Thrombus.

PURPOSE: We report the first cases of direct current cardioversion (DCCV) performed during percutaneous left atrial appendage occlusion (LAAO) in patients with left atrial appendage thrombus and assess its technical feasibility. METHODS: Three patients with left atrial appendage thrombus and absolute indications for LAAO underwent DCCV during the procedure because of hemodynamic instability from rapid atrial fibrillation. RESULTS: A single 200-J shock restored sinus rhythm in all patients. No device migration, embolization, significant peridevice leak, or neurologic events occurred. Follow-up imaging confirmed stable device position. CONCLUSIONS: DCCV during LAAO appears technically feasible in selected patients, although larger studies are needed to confirm safety.